Preserving Sexual Function in Patients With Prostate Cancer

It may be possible to preserve sexual function in men with prostate cancer undergoing curative radiation therapy (RT) by using a vessel-sparing radiation technique, according to a 5-year follow-up of a group of men who underwent vessel-sparing radiation therapy in this setting.¹

The study included 90 men diagnosed with prostate cancer; about 50% underwent external beam RT alone and 50% had the external beam RT plus brachytherapy. No patient received androgen deprivation therapy.

“Using MRI to define the patient’s anatomy, the vessels involved in maintaining an erection can be spared in some patients,” explained author Patrick McLaughlin, MD, of the Univer­sity of Michigan Providence Cancer Institute in Novi. “This is not possible in all patients, for example, those with prostate cancer at the apex of the prostate,” he said.

All forms of cancer therapy affect sexual function, McLaughlin continued. A 2009 study found that among patients with good baseline erectile capacity, after 36 months erectile capacity was present in only one-third of those treated with prostatectomy, 50% of those who got external beam RT, and 80% of those who received brachytherapy.²

In 2005, McLaughlin and his colleagues defined the vessel-sparing technique. At the 2014 ASTRO annual meeting, he presented a 5-year follow-up on patients treated with it.

Two patient-reported metrics were used to assess sexual function: Metric A, which measured erections sufficient for sexual intercourse; and Metric B, which was more general about any form of sexual activity.

Using Metric A, which looked only at erectile function sufficient for sexual intercourse, at 2 years, erectile capacity was achieved in 16.5% of those in the RT-alone group and 20.8% of the group receiving RT plus brachytherapy. At 5 years, 15.4% and 16.9%, respectively, were able to maintain an erection.

Using Metric B, erectile function sufficient for sexual activity with or without aids was preserved in 78.6% of RT-alone patients and 91.8% of those who received RT plus brachytherapy at 5 years.

McLaughlin said that as people age, sexuality changes and many couples engage in types of sexual activity other than sexual intercourse, which can be painful to women after menopause. That’s why he thinks Metric B is more reflective of sexuality in older people.

Cure rates were excellent. At 5 years, cure rates were 98% among low-risk men (55% of the 90 patients), 96% among intermediate-risk men (30% of the patients), and 87% in the high-risk patients (5% of the sample).

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References

1. Liss AL, Evans C, Narayana V, et al. Comparison of external beam and combination therapy for prostate cancer: patient reported outcomes of sexual function with 5-year follow-up. Int J Radiat Oncol Biol Phys. 2014;90(1)(suppl):S54. Presented at: 56th Annual Meeting of the American Society for Radiation Oncology; September 14-17, 2014; San Francisco, CA. Abstract 111.
2. Chen RC, Clark JA, Talcott JA. Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function. J Clin Oncol. 2009;27(24):3916-3922.